Primary Care Physicians’ Perceptions of Bariatric Surgery and Major Barriers to Referral

Abstract

Background Each year from 2011 to 2017, fewer than 1% of eligible Americans underwent bariatric surgery to treat obesity and obesity-related comorbidities. Recent studies have suggested that a lack of knowledge within the primary care specialty about the safety and efficacy of bariatric surgery greatly affects referral. This study aimed to analyze a large cohort of primary care physicians' (PCPs) clinical perceptions regarding bariatric surgery and to identify major barriers to referral that could inform the implementation of a future educational strategy to address underutilization of bariatric surgery. Study Design A prospective anonymous electronic survey was sent to all primary care physicians at a multicenter communitybased academic hospital system between March and June of 2018, with 150 respondents, a response rate of 28%. The survey was composed of eleven questions in total, the first eight utilizing a five-point Likert scale, with answers including strongly disagree, disagree, neutral, agree, and strongly agree. The final three questions utilized freeform answers of numbers or text where appropriate.Results Between 83 and 88% of PCPs responded favorably, either agree or strongly agree, to questions regarding the utility of bariatric surgery as an efficacious and valuable tool for the treatment of obesity and related comorbidities. PCPs reported an average body mass index (BMI) of 40.4 ± 5.0 kg/m 2 at which bariatric surgery is a patient's best option for weight loss and an average BMI of 38.0 ± 5.6 kg/m 2 at which surgery is the best option for management of comorbidities. Eighty-six percent of PCPs agree that having a BMI over 40 kg/m 2 is a greater risk to a patient's long-term health than undergoing bariatric surgery. However, only 46.6% of PCPs claimed any familiarity with the NIH eligibility criteria for bariatric surgery and only 59.5% responded affirmatively that they were comfortable participating in the long-term care of a postoperative bariatric patient. The two highest reported barriers to referral for bariatric surgery together account for 40% of PCPs responses: 21.5% of PCPs report concern regarding surgical complications and/or long-term side effects as the primary barrier for referral, and 18.5% report concern for ineffective weight loss after bariatric surgery as a primary barrier to referral. Conclusion Results of this study indicate that despite largely positive attitudes toward the use of bariatric surgery in a patient population with obesity, primary care physicians report significant barriers to confidently referring their own patients. Further, bariatric surgery is overlooked in a large group of patients with BMIs between 35 and 40 kg/m 2 . Educational strategies to address these barriers should target rates of specific surgical complications and weight loss outcomes.

Patient‐provider discussions of bariatric surgery and subsequent weight changes and receipt of bariatric surgery

“…Surveys of primary care physicians have shown that few of them are familiar with the NIH guidelines for management of obesity (37,38), many are not confident in their competency to discuss bariatric surgery with their patients (39,40), and many believe that bariatric surgery is likely to lead to complications (38,40,41). Many primary care providers do not feel that bariatric surgery is the best way to manage excess weight of patients with a BMI between 35 and 40 (38), which was the BMI range of the majority of patients in this study. Therefore, it is likely that providing primary care and other referring physicians with more information on the efficacy and safety of bariatric surgery could increase rates of discussion of this procedure with their patients as well as subsequent referrals.…”

Cost effectiveness of bariatric surgery in patients with obesity related comorbidities

“…[ 25 26 ] One of the significant barriers for non-referral of patients with obesity for bariatric surgery among PCPs is their non-comfortable participation in the long-term care of a postoperative bariatric patient including management of long-term side effects and perceived ineffectiveness of bariatric surgery. [ 27 ] It is well understood that PCPs are on the frontlines and they are the ones who can easily diagnose and recommend weight loss management for morbid obesity. This study reinforces the economic benefit for patients with obesity to be referred for bariatric surgery, and PCPs who are on the frontlines may reconsider these benefits (not only its health advantages) to refer patients for surgical intervention.…”

Knowledge, attitude and practice of bariatric surgery among primary care physicians in Riyadh, 2020

“…79.3 % and 33.9% were less likely to talk about bariatric surgery and less likely to feel comfortable explaining procedure choices and postoperative care, respectively. Other studies found that more than half of their enrolled physicians were not familiar with the NIH morbid obesity management guidelines (Avidor et al, 2007;Conaty et al, 2019). The aim of this study was to identify knowledge, attitude, and practice of bariatric surgery among PHCP's in Riyadh, Saudi Arabia.…”